Clinical guidelines

Supporting smoking cessationA guide for health professionals

Introduction

Australia has made major progress in tobacco control with population prevalence of smoking falling substantially since the 1960s. In recent years smoking rates have continued to fall, including in the Aboriginal and Torres Strait Islander population for the first time – where rates have been unacceptably high.1,2,3 However, despite the decline in prevalence, smoking remains the behavioural risk factor responsible for the highest levels of preventable disease and premature death.4 The task of further reducing the number of Australians who are using tobacco requires a collaborative effort between government, health authorities, health professionals and the community at large.

The former chief adviser to the Australian Government on tobacco control, Professor David Hill, has likened tobacco control efforts to keeping a spring compressed – take the pressure off and rates of tobacco use, and the harm that follows, will rebound. Tobacco control involves preventing uptake and supporting cessation. Health professionals play a key role in both, but have a particular responsibility to assist all smokers to stop.5,6 Reducing parental smoking rates is the intervention with the clearest effect on youth smoking uptake.

Two publications, Smoking cessation guidelines for Australian general practice (2004)7 and Smoking cessation pharmacotherapy: an update for health professionals (2009),8 provided a framework for assisting quitting, and informed health professionals of developments in the understanding of nicotine addiction and the pharmacotherapies available to assist smoking cessation. These publications were based on a literature review undertaken for the National Tobacco Strategy,9 experience with cessation programs in Australia – in particular the Smokescreen Program10 – and international experience with smoking cessation guidelines in other countries.11–14

Since these publications, there have been important developments in both the science and practice of cessation support. These include advances in our understanding of the neurobiology of nicotine addiction, further research on the use of varenicline and substantial changes in the approved use of nicotine replacement therapy (NRT). Another important development for smoking cessation in Australia has been the listing of nicotine patches on the Pharmaceutical Benefits Scheme (PBS), initially for Aboriginal and Torres Strait Islander people in 2008, and for the general community since February 2011. In recognition of the emerging evidence and the need to keep this guide current, updates were done in June 2012 and 2014.

Supporting smoking cessation: a guide for health professionals aims to be a practical, succinct and evidence-based resource that can be used by a wide range of health professionals working in a variety of contexts. As with the previous publications, it is based on research evidence and is informed by guidelines from other countries with similar population profiles. It seeks to link smoking cessation advice by health professionals to the materials and support services provided through the telephone quitlines operating in each state and territory. It also seeks to build on the momentum for cessation gained by public health interventions such as tax increases, restrictions on smoking in public places, changes to tobacco display and packaging and the social marketing of smoking cessation.